NIHR Signal Rotavirus vaccine estimated to have saved the NHS £12.5 million a year

Published on 21 February 2017

The introduction of the rotavirus vaccine in July 2013 has reduced rates of infectious diarrhoea (acute gastroenteritis) in children up to five years by 15%, with a 41% reduction during February to April, when rotavirus incidence is traditionally high.

This NIHR-funded study used time series data to calculate the fall in infectious diarrhoea episodes after the introduction of the vaccine. The resulting reduced contact with the NHS was estimated to have saved the NHS in England £12.5 million from July 2013 to June 2014. Savings were calculated from data collected in GP surgeries, hospitals and emergency departments. Two thirds of the savings came from reduced hospitalisation costs.

Vaccine coverage is good, at around 90%, but is lower in some geographic locations and ethnic groups. Future work is needed to understand why uptake is not higher. However, these preliminary findings suggest that the vaccination programme has successfully reduced burden on the NHS across both primary and secondary care settings.

Rotavirus vaccine estimated to have saved the NHS £12.5 million a year

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Why was this study needed?

Rotavirus is the most common cause of infectious diarrhoea in children. Nearly every child will have at least one episode of rotavirus by five years of age. The virus typically strikes babies and young children, causing diarrhoea and sometimes vomiting, stomach ache and fever. Most children recover at home within a few days, but nearly one in five will need to see their doctor, and one in 10 of these end up in hospital as a result of complications. A very small number of children die from rotavirus infection each year.

In July 2013, the NHS introduced a childhood vaccination programme against rotavirus infection. The aim of this study was to investigate the reduction in incidence of infectious diarrhoea in children for the two years after the introduction of the vaccine, and calculate the likely healthcare savings due to reduced number of visits to NHS facilities.

What did this study do?

The researchers used routinely collected NHS contact data from the Clinical Practice Research Datalink database, Hospital Episode Statistics and the Emergency Department Syndromic Surveillance System. They recorded the number of infectious diarrhoea episodes per month for children up to five years of age pre-vaccination were taken from July 2008 to June 2013, and post vaccination from July 2013 to April 2015.

Monthly incidence rates were modelled using age-stratified time series. Costs per visit were calculated from a number of NHS data sources from GP surgeries, hospitals and emergency departments.

The authors used reasonable assumptions in their model and corrected for other possible factors that might have impacted on the incidence of childhood infectious diarrhoea, such as temperature and rainfall.

What did it find?

  • Rates of infectious diarrhoea in children up to five years fell by 15% overall in the two years following introduction of the vaccine (adjusted Incidence Rate Ratio [IRRa] 0.85, 95% confidence interval [CI] 0.76 to 0.95). The greatest reduction of 41% was seen between February to April, when rotavirus incidence is traditionally high (IRRa 0.59, 95% CI 0.53 to 0.66).
  • The reduced number of healthcare visits of children up to five years because of this fall in incidence of infectious diarrhoea was estimated to have saved the NHS in England £12.5 million from July 2013 to June 2014.
  • Savings came from reduced numbers of visits to GPs (64,457 fewer visits, savings of £2.7 million), hospitals (12,683 fewer visits, £8.5 million savings), and emergency departments (10,236 fewer visits, £1.2 million savings).
  • Incidence rates of infectious diarrhoea in older children and to a lesser extent in adults also fell, indicating herd immunity. This is an indirect effect where if a high proportion of the population is vaccinated, it is harder for the disease to spread.

What does current guidance say on this issue?

Guidance in Public Health England’s Green Book 2015 states that the oral vaccine (Rotarix) should be provided in two doses. The first vaccine dose of 1.5 ml of Rotarix should be swallowed at two months (approximately eight weeks) of age, with the second dose of 1.5 ml at least four weeks after the first dose.

Rotavirus  vaccine  can  be  given  at  the  same  time  as  the  other  vaccines  administered  as  part  of  the  routine  NHS childhood  immunisation  programme, including BCG, and so should ideally be given at the scheduled two month and three month vaccination visits.

What are the implications?

The winter of 2013/14 was mild and wet, and so rates were likely to be lower, as witnessed for example in the Netherlands where there is no vaccine. However, the reduced incidence of diarrhoea was sustained in England the following year, while it rose in the Netherlands, suggesting that reduced rates were due to the vaccine.

Over the first 14 months of the programme, rotavirus vaccine coverage for children averaged 93.3% for one dose and 88.3% for two doses. Coverage is lower in some locations and ethnic groups, and these inequalities could be investigated further.

Citation and Funding

Thomas SL, Walker JL, Fenty J, et al. Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted. Vaccine. 2017 23;35(4):680-686.

This project was funded by the National Institute for Health Research Protection Research Unit (NIHR HPRU) in partnership with Public Health England

Bibliography

NHS Choices. Rotavirus vaccine. London: NHS Choices; 2015.

Public Health England. Green Book (Immunisation against infectious disease). Chapter 27b. Rotavirus. London: Department of Health; 2015.

Public Health England. Rotavirus infant immunisation programme 2014/15: Vaccine uptake report on the temporary sentinel data collection for England. London: Public Health England; 2015.

Why was this study needed?

Rotavirus is the most common cause of infectious diarrhoea in children. Nearly every child will have at least one episode of rotavirus by five years of age. The virus typically strikes babies and young children, causing diarrhoea and sometimes vomiting, stomach ache and fever. Most children recover at home within a few days, but nearly one in five will need to see their doctor, and one in 10 of these end up in hospital as a result of complications. A very small number of children die from rotavirus infection each year.

In July 2013, the NHS introduced a childhood vaccination programme against rotavirus infection. The aim of this study was to investigate the reduction in incidence of infectious diarrhoea in children for the two years after the introduction of the vaccine, and calculate the likely healthcare savings due to reduced number of visits to NHS facilities.

What did this study do?

The researchers used routinely collected NHS contact data from the Clinical Practice Research Datalink database, Hospital Episode Statistics and the Emergency Department Syndromic Surveillance System. They recorded the number of infectious diarrhoea episodes per month for children up to five years of age pre-vaccination were taken from July 2008 to June 2013, and post vaccination from July 2013 to April 2015.

Monthly incidence rates were modelled using age-stratified time series. Costs per visit were calculated from a number of NHS data sources from GP surgeries, hospitals and emergency departments.

The authors used reasonable assumptions in their model and corrected for other possible factors that might have impacted on the incidence of childhood infectious diarrhoea, such as temperature and rainfall.

What did it find?

  • Rates of infectious diarrhoea in children up to five years fell by 15% overall in the two years following introduction of the vaccine (adjusted Incidence Rate Ratio [IRRa] 0.85, 95% confidence interval [CI] 0.76 to 0.95). The greatest reduction of 41% was seen between February to April, when rotavirus incidence is traditionally high (IRRa 0.59, 95% CI 0.53 to 0.66).
  • The reduced number of healthcare visits of children up to five years because of this fall in incidence of infectious diarrhoea was estimated to have saved the NHS in England £12.5 million from July 2013 to June 2014.
  • Savings came from reduced numbers of visits to GPs (64,457 fewer visits, savings of £2.7 million), hospitals (12,683 fewer visits, £8.5 million savings), and emergency departments (10,236 fewer visits, £1.2 million savings).
  • Incidence rates of infectious diarrhoea in older children and to a lesser extent in adults also fell, indicating herd immunity. This is an indirect effect where if a high proportion of the population is vaccinated, it is harder for the disease to spread.

What does current guidance say on this issue?

Guidance in Public Health England’s Green Book 2015 states that the oral vaccine (Rotarix) should be provided in two doses. The first vaccine dose of 1.5 ml of Rotarix should be swallowed at two months (approximately eight weeks) of age, with the second dose of 1.5 ml at least four weeks after the first dose.

Rotavirus  vaccine  can  be  given  at  the  same  time  as  the  other  vaccines  administered  as  part  of  the  routine  NHS childhood  immunisation  programme, including BCG, and so should ideally be given at the scheduled two month and three month vaccination visits.

What are the implications?

The winter of 2013/14 was mild and wet, and so rates were likely to be lower, as witnessed for example in the Netherlands where there is no vaccine. However, the reduced incidence of diarrhoea was sustained in England the following year, while it rose in the Netherlands, suggesting that reduced rates were due to the vaccine.

Over the first 14 months of the programme, rotavirus vaccine coverage for children averaged 93.3% for one dose and 88.3% for two doses. Coverage is lower in some locations and ethnic groups, and these inequalities could be investigated further.

Citation and Funding

Thomas SL, Walker JL, Fenty J, et al. Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted. Vaccine. 2017 23;35(4):680-686.

This project was funded by the National Institute for Health Research Protection Research Unit (NIHR HPRU) in partnership with Public Health England

Bibliography

NHS Choices. Rotavirus vaccine. London: NHS Choices; 2015.

Public Health England. Green Book (Immunisation against infectious disease). Chapter 27b. Rotavirus. London: Department of Health; 2015.

Public Health England. Rotavirus infant immunisation programme 2014/15: Vaccine uptake report on the temporary sentinel data collection for England. London: Public Health England; 2015.

Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted

Published on 23 December 2016

Thomas, S. L.,Walker, J. L.,Fenty, J.,Atkins, K. E.,Elliot, A. J.,Hughes, H. E.,Stowe, J.,Ladhani, S.,Andrews, N. J.

Vaccine , 2016

BACKGROUND: Introduction of infant oral rotavirus vaccination in the UK in July 2013 has resulted in decreased hospitalisations and Emergency Department (ED) visits for acute gastroenteritis (AGE), for both adults and children. We investigated reductions in AGE incidence seen in primary care in the two years after vaccine introduction, and estimated the healthcare costs averted across healthcare settings in the first year of the vaccination programme. METHODS: We used primary care data from the Clinical Practice Research Datalink and age-stratified time-series analyses to derive adjusted incidence rate ratios (IRRa) for AGE in the first two years of the post-vaccination era (July 2013-April 2015) compared to the pre-vaccination era (July 2008-June 2013). We estimated cases averted among children aged <5years in the first year of the vaccination programme by comparing observed numbers of AGE cases in 2013-2014 to numbers predicted from the time-series models. We then estimated the healthcare costs averted for general practice consultations, ED visits and hospitalisations. RESULTS: In general practice, AGE rates in infants (the target group for vaccination) decreased by 15% overall after vaccine introduction (IRRa=0.85; 95%CI=0.76-0.95), and by 41% in the months of historically high rotavirus circulation (IRRa=0.59; 95%CI=0.53-0.66). Rates also decreased in other young children and to a lesser degree in older individuals, indicating herd immunity. Across all three settings (general practice, EDs, and hospitalisations) an estimated 87,376 (95% prediction interval: 62,588-113,561) AGE visits by children aged <5years were averted in 2013-14, associated with an estimated pound12.5million (9,209-16,198) reduction in healthcare costs. CONCLUSIONS: The marked decreases in the general practice AGE burden after rotavirus vaccine introduction mirror decreases seen in other UK healthcare settings. Overall, these decreases are associated with substantial averted healthcare costs.

The Clinical Practice Research Datalink (CPRD) is a governmental, not-for-profit research service, jointly funded by the NHS National Institute for Health Research (NIHR) and the Medicines and Healthcare products Regulatory Agency (MHRA). It provides anonymised primary care records for public health research, and has been running since 1987.

Hospital Episodes Statistics (HES) is a data warehouse containing records of all patients admitted to NHS hospitals in England. It contains details of every hospital stay in English NHS Hospitals and English NHS commissioned activity in the independent sector.

The Emergency Department Syndromic Surveillance System (EDSSS) monitors the daily visits in a network of emergency departments across England and Northern Ireland. It is run by Public Health England.

Expert commentary

The introduction of new routine vaccines requires considerable investment in health services and must be cost-effective. In addition to reducing the burden of disease due to acute gastroenteritis in children, the evidence presented here suggests that infant rotavirus vaccination can avert tens of thousands of health consultations and over £10 million per annum in health care costs.

This study once again reminds us of the prime importance of vaccination as a public health intervention, but we must always remember that in addition to reductions in healthcare costs, the reduction in angst for parents of young children must be priceless.

Dr Allison Duggal, Deputy Director Public Health, Kent County Council